198015837-1-26-2023-54-CC-AESA-CNFU52-20230126141602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015837
Report Date: 01/26/2023
Date Signed: 01/26/2023 02:17:02 PM

Document Has Been Signed on 01/26/2023 02:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	RODRIGUEZ FAMILY CHILD CARE		FACILITY NUMBER:	198015837
ADMINISTRATOR:	RODRIGUEZ, ANGELICA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(949) 482-7894
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90037
CAPACITY:	14	CENSUS: 11	DATE:	01/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Licensee Angelica Rodriguez		TIME COMPLETED:	02:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 1/26/23 at 12:05 PM Licensing Program Analysts (LPAs) Austin Estrada and Jeanette Estrada conducted an unannounced required 1-year inspection at the above facility. LPAs met with the Licensee Angelica Rodriguez and informed her of the purpose for the visit. LPA provided the inspection Entrance Checklist (LIC 126). Licensee guided LPAs on a tour of the facility. There were 11 children (2 infants 9 toddlers) and 1 additional staff present during the inspection. All adults present during the inspection have obtained a criminal record clearance or exemption. Individuals residing in the home have been discussed and noted. Licensee provides care to children ages 6 months to 5 years old and operation days/ hours are Monday through Friday 8 AM to 4 PM. This is a one story home which consists of three bedrooms, and 2.5 bathrooms. Areas used by the children in care include the living room, 2 bathrooms (one which is located in the backyard next to the classroom), backyard, and classroom located in the back. Per Licensee, areas off limits to children include: three bedrooms (locked), kitchen, and dining area and one bathroom. All areas identified on the facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness. The following was observed and reviewed during this inspection: LPAs reviewed required posted documentation for Facility License, Publication (PUB) 394- Notification of Parent Rights and Licensing Form (LIC) 9148- Earthquake Preparedness form. All documents were observed to be posted in classroom. Facility records were reviewed for LIC 9040- Facility Roster, LIC 610A- Emergency Disaster Plan and Verification of Disaster and Fire Drills. The last drill was conducted on 12/23/22. All documents were observed during the inspection. There is an operable carbon monoxide detector and a smoke detector in the home. A fully charged Fire extinguisher (2A10BC) was observed and last serviced on 3/18/22.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 198015837
	VISIT DATE: 01/26/2023

NARRATIVE

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The home maintains telephone service (mobile). LPAs observed cleaning compounds, and sharp objects such as knives located in the off limits kitchen area inaccessible to children in care. Per Licensee, no children require medication. Per Licensee, personal medication is located in an off limits bedroom inaccessible to children in care.

Per licensee there are no poisons stored in the home. LPAs advised Licensee that all poisons must be locked away, not only inaccessible. Isolation area for sick children waiting to be picked up is in the classroom, away from the other children. Per Licensee there are no firearms or weapons stored in the home.

Food is provided by Licensee. LPAs advised Licensee if children bring food from home it must be labeled with the child’s name and properly stored or refrigerated.

The home is observed to be clean and orderly. There are toys and other age-appropriate materials available for children. The outdoor play area was observed to be fenced and contain toys and other age- appropriate materials available for children. Per Licensee, children are supervised while playing outside. Per Licensee, care and supervision is provided in the classroom located in the backyard. Occasionally, when it rains Licensee will provide care and supervision inside the home. Licensee provides sleeping cots for each child. LPAs did not observe any pools, spas, or other bodies of water. During the inspection, children present was observed to be treated with dignity and respect, observed to be receiving safe, healthful, and comfortable accommodations, furnishings, and equipment, and free from corporal and/or unusual punishment.

Children’s records were reviewed for (LIC) 282- Affidavit Regarding Liability Insurance, Immunization Records, LIC 700- Identification and Emergency Information, LIC 627- Consent for Medical Treatment, LIC 995A Notification of Parents’ Rights, LIC 9227- Infant sleep form (0-12 months, and documentation of 15-minute Infant Sleep Check (0-24 months). Licensee did not have infant sleep log for two infants at the time of inspection.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 508-Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunizations against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, and LIC 9108- Statement of Child and Mandated Reporter Training Certificate. Licensee’s CPR/First Aid expires on 02/2024 and Mandated Reporter Training Certificate was completed on 08/31/22.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: RODRIGUEZ FAMILY CHILD CARE	FACILITY NUMBER: 198015837
	VISIT DATE: 01/26/2023

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Infant Care: Currently licensee cares for 2 infants. Infants sleep on a napping mat. Each infant has their own napping mat and bedding. LPA reviewed Safe sleep regulations with Licensee, including LIC 9227 (Infant Sleep Plan) for infants under 12 months and 15-minute sleep check documentation for infants 0-24 months. LPA discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA provided a copy of PIN 20-24-CCP: Recently Approved Safe Sleep Regulations in Effect.
Overnight Care: Per Licensee, there is no overnight care is not provided at the moment
Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing IMS must be submitted to the Department.
The following information regarding ADA was provided: US Department of Justice (USDOJ) toll free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm
LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
LPA advised Licensee that all adults age 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Based on the LPA’s observation and record review no deficiencies will be cited today 1/26/23.
An exit interview was conducted and report was reviewed with Licensee, Angelica Rodriguez.
A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty.
Appeal rights were discussed and provided to the Licensee.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin Estrada	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023

LIC809 (FAS) - (06/04)

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